Fibrinogen in traumatic haemorrhage: A narrative review

Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes. Hence, it has been postulated that early fibrinogen replacement in severe traumatic haemorrhage may improve outcomes, although, to date there is a paucity of high quality evidence to support this hypothesis. In addition there is controversy regarding the optimal method for fibrinogen supplementation. We review the current evidence regarding the role of fibrinogen in trauma, the rationale behind fibrinogen supplementation and discuss current research.Griffith Health, School of Medical ScienceNo Full Tex

Nectar palatability can selectively filter bird and insect visitors to coral tree flowers

Secondary compounds in nectar may play a decisive role in determining the spectrum of floral visitors on plants. Flowers of the African coral tree Erythrina caffra are visited mainly by generalist passerine nectarivores, such as weavers and bulbuls. As the nectar of this species tastes very bitter to humans, it was hypothesized that secondary compounds may repel sunbirds and honeybees which are common in the same habitats yet seldom consume the nectar. We conducted choice tests using fresh nectar and both sucrose and hexose (glucose/fructose) solutions of the same concentration as the nectar. Whitebellied Sunbirds (Cinnyris talatala) were repelled by nectar of both E. caffra and a related species Erythrina lysistemon, but Dark-capped Bulbuls (Pycnonotus tricolor) did not discriminate between the Erythrina nectar and control sugar solution in terms of amounts consumed. Honeybees (Apis mellifera scutellata) probed exposed droplets of E. caffra nectar and a control sugar solution at the same rate, suggesting that there is no volatile deterrent, but they immediately withdrew their proboscis far more often from the droplets of Erythrina nectar than they did from the sugar solution, suggesting that they find Erythrina nectar distasteful. These results contribute to a growing awareness that non-sugar components of nectar can play important functional roles in plant pollination systems.South African National Research Foundation (NRF)http://link.springer.com/journal/106822016-03-31hb201

The TRPM2 channel nexus from oxidative damage to Alzheimer’s pathologies: An emerging novel intervention target for age-related dementia

Alzheimer’s disease (AD), an age-related neurodegenerative condition, is the most common cause of dementia among the elder people, but currently there is no treatment. A number of putative pathogenic events, particularly amyloid β peptide (Aβ) accumulation, are believed to be early triggers that initiate AD. However, thus far targeting Aβ generation/aggregation as the mainstay strategy of drug development has not led to effective AD-modifying therapeutics. Oxidative damage is a conspicuous feature of AD, but this remains poorly defined phenomenon and mechanistically ill understood. The TRPM2 channel has emerged as a potentially ubiquitous molecular mechanism mediating oxidative damage and thus plays a vital role in the pathogenesis and progression of diverse neurodegenerative diseases. This article will review the emerging evidence from recent studies and propose a novel ‘hypothesis’ that multiple TRPM2-mediated cellular and molecular mechanisms cascade Aβ and/or oxidative damage to AD pathologies. The ‘hypothesis’ based on these new findings discusses the prospect of considering the TRPM2 channel as a novel therapeutic target for intervening AD and age-related dementia

Inflammatory and mucociliary dysfunction based endotypes across the spectrum of chronic airways diseases

Introduction: There is substantial overlap between COPD, asthma, bronchiectasis(BE) and cystic fibrosis(CF) and each is characterised by inflammation and mucociliary dysfunction.Hypothesis: Biology, rather than disease labels, may stratify patients into therapeutically relevant subtypes.Methods: Patients were categorized by primary disease and clinical characteristics, spontaneous sputum was collected and inflammatory characteristics (neutrophil elastase(NE) and 19 cytokines) and sputum properties (DNA content, mucins, rheology, dry weight) measured. K-means clustering was performed and parameters compared between and within disease groups. Smokers without respiratory disease were used as controls.Results: The study included patients with asthma(76), COPD(91), BE(54), CF(24) and controls(26). 10 cytokines, NE, dry weight, mucins and multiple sputum parameters were different between disease groups and healthy controls (p<0.05). K means clustering identified 2 clusters defined by neutrophilic (N) or eosinophilic (E) inflammation. The E cluster was associated with lower dry weight, DNA content and higher mucins, particularly MUC5B. The rheology parameters G’ and G* were significantly higher in the E group while Tan(delta) was higher in the N group (p<0.05 all comparisons). Both clusters were present in all disease groups with more neutrophilic inflammation in CF and BE (42% of COPD patients and 46% of asthma patients were neutrophilic vs 78% of BE and 87% of CF,p<0.0001).Conclusion: Airways diseases have heterogenous inflammatory and mucus parameters. Assessment based on disease labels may be aided by endotyping using inflammatory and mucociliary clearance parameters

Inflammatory and mucociliary dysfunction based endotypes across the spectrum of chronic airways diseases

Introduction: There is substantial overlap between COPD, asthma, bronchiectasis(BE) and cystic fibrosis(CF) and each is characterised by inflammation and mucociliary dysfunction.Hypothesis: Biology, rather than disease labels, may stratify patients into therapeutically relevant subtypes.Methods: Patients were categorized by primary disease and clinical characteristics, spontaneous sputum was collected and inflammatory characteristics (neutrophil elastase(NE) and 19 cytokines) and sputum properties (DNA content, mucins, rheology, dry weight) measured. K-means clustering was performed and parameters compared between and within disease groups. Smokers without respiratory disease were used as controls.Results: The study included patients with asthma(76), COPD(91), BE(54), CF(24) and controls(26). 10 cytokines, NE, dry weight, mucins and multiple sputum parameters were different between disease groups and healthy controls (p<0.05). K means clustering identified 2 clusters defined by neutrophilic (N) or eosinophilic (E) inflammation. The E cluster was associated with lower dry weight, DNA content and higher mucins, particularly MUC5B. The rheology parameters G’ and G* were significantly higher in the E group while Tan(delta) was higher in the N group (p<0.05 all comparisons). Both clusters were present in all disease groups with more neutrophilic inflammation in CF and BE (42% of COPD patients and 46% of asthma patients were neutrophilic vs 78% of BE and 87% of CF,p<0.0001).Conclusion: Airways diseases have heterogenous inflammatory and mucus parameters. Assessment based on disease labels may be aided by endotyping using inflammatory and mucociliary clearance parameters

Fibrinogen Early In Severe Trauma studY (FEISTY): study protocol for a randomised controlled trial

Abstract Background Haemorrhage is a leading cause of death in severe trauma. Fibrinogen plays a critical role in maintaining haemostasis in traumatic haemorrhage. Early fibrinogen replacement is recommended by several international trauma guidelines using either fibrinogen concentrate (FC) or cryoprecipitate (Cryo). There is limited evidence to support one product over the other with widespread geographic and institutional variation in practice. This pilot trial is the first randomised controlled trial comparing FC to Cryo in traumatic haemorrhage. Methods/design The Fibrinogen Early In Severe Trauma studY (FEISTY) is an exploratory, multicentre, randomised controlled trial comparing FC to Cryo for fibrinogen supplementation in traumatic haemorrhage. This trial will utilise thromboelastometry (ROTEM®) to guide and dose fibrinogen supplementation. The trial will recruit 100 trauma patients at four major trauma centres in Australia. Adult trauma patients with evidence of haemorrhage will be enrolled on arrival in the trauma unit and randomised to receiving fibrinogen supplementation with either FC or Cryo. The primary outcome is the differential time to fibrinogen supplementation. There are a number of predetermined secondary outcomes including: effects of the intervention on plasma fibrinogen levels, feasibility assessments and clinical outcomes including transfusion requirements and mortality. Discussion The optimal method for replacing fibrinogen in traumatic haemorrhage is fiercely debated. In this trial the feasibility and efficacy of fibrinogen supplementation using FC will be compared to Cryo. The results of this pilot study will facilitate the design of a larger trial with sufficient power to address patient-centred outcomes. Trial registration ClinicalTrials.gov, ID: NCT02745041 . Registered 4 May 2016

Additional file 1: of Fibrinogen Early In Severe Trauma studY (FEISTY): study protocol for a randomised controlled trial

FEISTY SPIRIT Checklist (DOC 66 kb)